Pituitary spindle cell oncocytoma: illustrative case.

Taha M Taka,Alvin Y Chan,Edward C Kuan,Scott G Turner,Joshua N Limbo,Chen Yi Yang,Jordan Davies,Frank P K Hsu

doi:10.3171/case21356

Taha M Taka, Alvin Y Chan + Show 6 more

Open Access

https://doi.org/10.3171/case21356

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Abstract

BACKGROUNDSpindle cell oncocytoma (SCO) of the pituitary gland is an extremely rare nonfunctional World Health Organization grade I tumor. SCOs are often misdiagnosed as nonfunctional pituitary adenomas on the basis of preoperative imaging. They are often hypervascular and locally adherent, which increases hemorrhage risk and limits resection, leading to increased risk of recurrence. The authors report a case of SCO treated at their institution and provide a review of the current literature.OBSERVATIONSSCO of the pituitary gland can be a rare cause of progressively growing pituitary tumors that presents similarly to nonfunctional pituitary adenoma. Endoscopic transsphenoidal resection of the tumor by a multidisciplinary team allowed total resection despite local adherence of the tumor. Postoperatively, the patient’s visual symptoms improved with persistence of secondary adrenal insufficiency and secondary hypothyroidism.LESSONSCareful resection is needed due to SCO’s characteristic hypervascularity and strong adherence to minimize local structure damage. Long-term follow-up is recommended due to the tendency for recurrence.

Highlights

Spindle cell oncocytoma (SCO) of the pituitary gland is an extremely rare nonfunctional World Health Organization grade I tumor
We describe the clinical course, resection, and postoperative period of SCO of the pituitary along with a literature review of case reports of SCO presentation and treatment
Total resection of the tumor was achieved with improvement of visual symptoms and persistence of secondary adrenal insufficiency and secondary hypothyroidism

Summary

BACKGROUND

Spindle cell oncocytoma (SCO) of the pituitary gland is an extremely rare nonfunctional World Health Organization grade I tumor. Spindle cell oncocytoma (SCO) is an extremely rare nonfunctional neoplasm of the pituitary gland It was first reported in a case series in 2002 by Roncaroli et al.,[1] and since they have been included in the 2007 World Health Organization (WHO) tumor classification of the central nervous system. SCO of the pituitary was described with the following characteristics: (1) many fascicles of spindle cells with an eosinophilic, granular cytoplasm, and numerous mitochondria; (2) no expression of pituitary hormones and synaptophysin; (3) immunoreactivity to vimentin, epithelial membrane antigen, S-100 protein, and galectin-3; and (4) lack invasion and demonstrated low proliferative activity.[1] SCOs are generally difficult to diagnose or are misdiagnosed preoperatively based on imaging alone due to the similarities with nonfunctional pituitary adenomas as well as the relatively rare presentation of SCO. We provide an extensive review of the literature to aid in managing this rare disease

Illustrative Case

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